CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 476 288.000000 10656.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1349 6483.750000 239872.8500 36.9960
Subtotal (Total Children Is Unduplicated) 1369 6771.750000 250528.8500 36.9962
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Screening, Eval, and Assessment,Class #02
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 63.1400 63.1400
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 12 22.000000 1221.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 176 317.500000 23762.5000 74.8425
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 57 107.000000 8025.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 51 89.000000 6556.7500 73.6713
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 240 435.500000 24070.2500 55.2704
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 57.000000 4148.2500 72.7763
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 19 19.000000 969.9500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 28 28.000000 1429.4000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 348 1138.000000 74158.5400 65.1657
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 53 53.000000 2650.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 70 70.000000 3500.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 30 30.000000 750.0000 25.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 9 9.000000 450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 44 44.000000 2200.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 110 110.000000 5500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 14.000000 350.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 157.000000 3925.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 890 5781.000000 289050.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 68 278.500000 13925.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 896 6114.000000 61140.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 43 195.000000 13930.8000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 214.3200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 47 126.500000 7235.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 12 18.500000 1321.6400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 12.500000 893.0000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 39 214.750000 12275.1100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 59 153.750000 10983.9000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 15.000000 1071.6000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 59 170.000000 9724.0000 57.2000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 7.000000 400.4000 57.2000
TRAV-TRAVS-Travel by mile 13 2003.000000 891.3100 0.4450
Subtotal (Total Children Is Unduplicated) 1023 15591.50000 442881.8800 28.4053
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Total 23501.250000 767569.2700 32.6608
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Number of Children (Unduplicated) With at Least One Service 1535
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Center 57
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 850 1302.500000 53915.7500 0.0000
P 1685 2218.750000 93755.5000 102202.4700
D 0 0.000000 0.0000 0.0000
S 13 13.000000 663.6500 663.6500
H 0 0.000000 0.0000 0.0000
T 2856 10724.000000 193665.0200 193491.3700
4675 9200.250000 424013.3500 251971.7200
Other 37 42.750000 1556.0000 640.2500
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Total 10116 23501.250000 767569.2700 548969.4600